I have a patient who has taken a certain medication for about 10 years. It has hoped her maintain her life. Without it she becomes profoundly depressed. Recently her health insurance company was changed. The new one will not cover the medication. Your doctor might prescribe a medication you need. You might have to find out which insurance company covers it.

Medco is one of the largest pharmacy benefit managers (PBM) in the country. Millions of patients fill 90 day mail order prescriptions through them. In partnership with insurance companies such as Blue Cross, their database contains vast amounts of information. When you go to the doctor, use your insurance to pay for the visit and then get a prescription filled, Medco knows your provider, your name, your diagnosis and your medication.

Medications for epilepsy, which are also used to treat bipolar disorder, have recently been identified by the FDA as being associated with suicidality. In June I received a letter from Medco informing me that one of my patients had been prescribed one of these anticonvulsants. It informed me that I should be aware that he might be suicidal.

I received that letter in June. The medication was first prescribed for him the previous December.

They advertise their ability to provide this information as being good for you, as improving medical care.

Think about this: I got their letter 6 months too late to have done any good. Medco has that patient labeled in their computer database as potentially suicidal.

Medco’s CEO’s total compensation in 2008 was $13,134,243. In 2008 the annual premium for an employer health plan covering a family of four averaged nearly $12,700. His compensation would pay the annual premium for 1,034 families.

Today I received an invitation from Shire (makers of Adderall and Vyvanse) to a dinner and discussion on August 5, 2009, two weeks from today. They sent it FedEx priority overnight and I had to interrupt my work to sign for it.

Buy them.
Let’s put the profits that health insurance companies make into the public coffers. The overhead of private insurance companies exceeds 20 percent. For Medicare it is less than five percent. Which system works better? When you turn 65, you qualify for Medicare, no matter how sick you are. If you are younger than 65, you had better keep your job.